Saturday, September 21, 2013

Doctors, Insurance, and Surgery Oh My: Hysteroscopy & Laparoscopy Done!

The past 5 days have been a whirlwind of doctors, nurses, surgery coordinators, and insurance companies. In my last post, I talked about how excited we were to FINALLY obtain insurance coverage for a hysteroscopy. This procedure would enable our RE to look for uterine polyps (possibly causing implantation issues) as well as to correct the uterine septum I was born with (possibly causing miscarriage/infertility issues). The hysteroscopy box has been left unchecked this whole time, but we've felt increasing urgency to do it lately, especially since we have now had 3 failed IVF transfers and have only two remaining embryos left on ice.

So, here I was....all scheduled for Friday's hysteroscopy. No big deal really. Then, I get a call from my RE asking how I would feel about adding a laparoscopy to my surgery. As many of you might know, the laparoscopy is another box many people like to check BEFORE they jump into more invasive fertility treatments. This procedure is more invasive and requires much more recovery than the hysteroscopy, but it allows the RE to get a complete view of the abdominal and pelvic organs and is used to diagnose and treat endometriosis, fibroids, cysts, and scar tissue. In fact, this is the ONLY procedure that allows for the diagnosis and treatment of endometriosis. Research has shown that even small amounts of endometriosis can result in infertility, and even IVF failure. Many times, hysteroscopy and laparoscopy will be performed simultaneously since they address different things related to infertility. 

Now, keep in mind we were presented with the option of doing laparoscopy way back when, after we hadn't had success with Clomid & Femara alone and were considering moving onto IUI or IVF. At that time however, we were told we were NOT covered for laparoscopy and that it would be a $12,000 surgery. We were given the choice of doing this very expensive surgery that might not find or solve anything, OR we could roll the dice with IUI or IVF. It was up to us. We made the decision to skip the surgery, mostly because we had zero insurance coverage for it. If it were FREE, you bet I would have chosen to do it a long time ago.

My RE is not the type of doctor that goes cutting into anyone unnecessarily either, and so he agreed with our decision to pursue IUI and IVF without ever having the laparoscopy done. He is also somewhat conservative and tries to get his patients pregnant with the least invasive means possible first.  A lot of his patients end up getting pregnant with pills, IUI, or IVF and never have to go through any surgical procedures whatsoever. Those people are very fortunate! Not to say that going through IVF is easy at all, but being able to skip any additional diagnostic surgeries and become pregnant is a bonus.

However, when you are like me...someone who has had fertility treatments for 26 months, 3 pregnancy losses, and 3 IVF transfers, still with no viable pregnancy, you find yourself going back to square one and asking yourself what's being missed....if you should bite the bullet and just have the surgeries to check things out for real, once and for all. I have never had anyone go in with a camera and actually look to see what's going on in there...nothing past two HSG's. As the IVF failures add up, it's begun to feel like we're throwing embryos into the vast unknown. 

Really, the only thing that's ever held us back from doing the lap was the cost of this darn surgery. Well, low and behold, all of a sudden for reasons unbenownst to me, I'm told we are now MAGICALLY covered for both the hysteroscopy and laparoscopy procedures under certain "medical coding" for my uterine septum?!?! I am trying not to get my panties in a giant wad over the lackluster timeliness of this miraculous occurrence and just focus on the fact that we have people working extra hard on our behalf to get something, ANYTHING covered with zero fertility or diagnostic coverage NOW....even if they didn't seem to work quite as creatively on our behalf before. I can't change the past, so I'm just trying to be grateful we are obtaining the coverage now.

We double and triple checked this week that both of these procedures would be covered under the medical coding being used. We even had our RE's surgery coordinator conference us into her phone call as she obtained benefits approval from our insurance company and recorded the entire conversation on mp3. Insurance companies rule the world, and you can never be too careful! I will believe it when I see the claim go through ultimately, but it looks like we were able to obtain coverage for $15,000 worth of surgeries for a mere $20 copay. So, my response to my RE was "Let's do this!"

Both laparoscopy and hysteroscopy were performed yesterday. Here are the findings (from what I remember/understand):

-uterine septum was excised...GONE!
-cyst found "all twisted up" into my left fallopian tube was removed
-scar tissue found on supporting ligament/entry into uterus (?) removed
-scar tissue found on liver removed
-NO endometriosis
-NO polyps


I'm told that if I wasn't already experiencing pain from the cyst on my fallopian tube, that it would have caused issues in the future, and it's good that it was removed. I have complained before of stabbing pains in the left fallopian tube/ovary area before, and very pronounced with both of my last pregnancies during the time when implantation would have been occurring. That is also the side where my suspected ectopic pregnancy occurred. Very interesting indeed.

Not sure where exactly the scar tissue was on this uterine ligament/structure/thingy, or what it could have affected...will have to gain a better understanding of this at my follow-up apt. I am beyond thrilled that there was no endometriosis or polyps. In a way I'm sure my RE could easily say, "See I told you so...didn't think you had either of these things present." On the other hand, at least now I know. I mean, how do you know until you check!? Most of all, I'm glad the uterine septum is gone, because that definitely could have been causing issue and also present issue with any future pregnancies.



So far, recovery has not been fun. The procedures took two hours. I had a few things cut out of there, and I'm definitely feeling sore and heavy and uncomfortable. There were three incisions made in my pelvic area, and there is still a balloon inside of me that won't be removed until two weeks from now at my follow-up appointment. It feels kind of similar to the day following an IVF retrieval...like you're walking around with a huge bag of marbles inside your abdomen, except more painful. I can't sit in a chair, but I can stand up and lie flat. I'm basically just rolling in and out of bed like I'm half paralyzed to pee and then go right back to watching tv and sleeping. We may not be able to try our last FET until November due to recovery time. However, I haven't had any nausea, and for that I'm thankful. So far so good in the whole scheme of things and no regrets; I have been through worse before (thyroid surgery) and I will get through this too.

With any surgery there are risks. There are people who have had horrible recovery experiences with laparoscopy and wish they'd never done it. Then there are others who've had easy recovery or found things that impacted their fertility, so it was worth it. There are also plenty of stories of those who became pregnant following this procedure as well. Everyone is different, but we are really happy we found a way to take a closer look inside finally. Things were found and taken care of during the procedures, and now I know once and for all if polyps or endo are playing a role.

If our final FET doesn't take, we feel we have a better picture of what we're actually dealing with and which forms of treatment are still feasible. We may not have $$ to keep doing IVF an endless amount of times, so we are thankful to have this broader picture of what's truly going on and what we have to work with going forward.

42 comments:

  1. So glad your insurance covered them both and you were able to have some issues taken care of/removed. I am so sorry it couldn't have done before. Its amazing how insurance companies rule the world. Praying for a quick recovering and continued healing- both mentally and physically!

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  2. What an amazing blessing the insurance coverage is! I am so happy all you had to pay out of pocket for is your copay. God is good. Now- you rest and recover. Praying its speedy. Xoxo big (careful) hugs!

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    1. God is good indeed. The same day I realized this, my insurance also covered a pre-pregnancy consult with a perinatologist that wasn't supposed to be covered. This is so unlike my insurance company, but I will take it....all of it! :)

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  3. I'm so glad everything went well with the surgeries and yay for the insurance coverage. I hope you recover fast and are able to move forward feeling good about having the full picture (literally) of what is/is not going on in there.

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    1. Thanks Bethany! Praying for a smooth transfer for you this week woman!

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  4. Emily, I'm happy for you that you have a "clean slate". At least, that's what I'd like to call it. :) You have answers to your previously unanswered suspicions, worries, etc. That must be a great feeling ... I am wondering if my upcoming WTF appointment will involve discussion of these tests ... Hmmm ... Get well soon! Praying for you!!!

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    1. It's worth asking about...at least hysteroscopy if nothing else. I know you can relate to wondering WTF is going on when you're putting what seem to look like normal embryos into your body but they aren't taking. Even though we didn't find polyps or endo, at least I know that is NOT what's causing the issue and I don't have to focus on wondering about it anymore.

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  5. Hi Emily, Just found your blog earlier today and spent a few hours on it. I must say i can really relate to you, as I am also a fitness freak, personal trainer, yoga instructor and "treat my body like its Taj Mahal" too (thought this was really funny; ) ). I am obssessed with healthy nutrition, and doing anything and everything possible to make myself as healthy and as baby ready as it can be. Currently i am into chinese medicine, accupuncture seems to be doing something right, at least for my PMS and period pain.. It hasn't been as long for me, as it was for you, although my journey isn't fun either) but i feel your pain. After reading a bunch of blogs this week I decided to also start my own, just to have a place to vent. Baby dust to you!

    Alyn http://babyhurryup.blogspot.ca/

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    1. Thanks for reading Alyn! Chinese medicine is great! I still try to adhere to a lot of the principles behind it, and I do believe it can be of great benefit!

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  6. First of all: WHOA, $20 copay for a lap is ridiculous! I was pretty impressed with my $420, and then they used an out of network assistant… dear Lord. But I'm super glad that the lap and hysteroscopy are over. I know there's a lot of stress surrounding that! Wishing you a speedy recovery and hoping the post-op gives you some answers!

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    1. Thanks Amanda! I think I've gotten all the answers we were looking for. If we need to do IVF again, I'll feel more comfortable that we aren't just throwing embryos into a uterus of polyps. And if we decide it's not in the financial cards for us to do IVF, it's good to know my body isn't riddled with endo and we could actually go back to the route of IUI if we really needed to. We just have a more realistic picture now and can weight the pros and cons of our options more easily.

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  7. Amazing! I would take $20 over what I paid any day. I am with u on the "all a sudden they have a way to code it so insurance covers it" I actually dealt with that an had to have a talk with them. When u tell me u can't do things to help bc it's fraud but u do it for urself to get $$$ that's not fraud? I'm glad everything worked out for you and hope ur recovery time gets better.

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    1. Well, in all fairness, it sounds like my situation was probably a little different. I think mine was more just a case of things slipping through the cracks in a large practice, and it took me finally having the right person on the other end of the phone to look through my entire chart THOROUGHLY before answering my questions about coverage and pricing. Unfortunately, I learned the hard way that RE's aren't the experts with billing and how medical coding works. I learned that you shouldn't always rely on them to breeze through your chart and tell you what your insurance will or will not cover. How can they possibly know without fully researching it? It's sad that we have to work so hard to advocate for ourselves sometimes, but that's just how it is.

      Our insurance plan did change from a PPO to an EPO this year as well, which should not have changed our covered benefits as far as I know, but it did change our deductible to $0...which has been a huge help with things that are covered. We have never had a $0 deductible ever before, but it seems to be making a huge difference with our costs on medical expenses that are actually covered.

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  8. Wow! What a whirlwind of a few days you've been through!! First- I'm SO glad that you ended up having these procedures and most of all that insurance COVERED them!!! That's amazing! Second, I'm hoping that you feel better soon! I am praying that by continuing to check things off your list, that you'll be in a much better place come FET time :) XOXO

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    1. I do already feel better moving forward with another FET knowing we aren't throwing these last two embryos into a polyp filled uterus or something. I'm not sure exactly how much hope I have left in these last two truthfully. We've already used 5 from the same batch and nothing, so was it just a "bad batch of eggs?" Who knows.

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  9. Wow!! What great news from your insurance that everything was covered! I bet you feel a lot of relief having crossed those off your list. I hope you have a quick recovery and this makes the difference for you next FET :)

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  10. So glad that you finally got insurance coverage and had these procedures done. It's great that it wasn't all for nothing, and you got some answers and improvements from it! Hoping your healing is quick!

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    1. Thanks Farra! They took some lovely pictures that I'm sure you would appreciate, but they wouldn't release them to me...said the were the only copy at the moment. I'll be sure to share them and gross everyone out once I get my hands on a copy. hehe

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  11. Emily, thank goodness you had coverage for all of that!! A mere $20, wow! What a blessing!! I'm so glad you had this done and glad the issues they found were fixed. I have a feeling once you are healed, the swelling is gone (I hope you do the prednisone again, you did get pregnant with it), then your November IVF is going to be that lucky one!! I know November is such a hard month for you, so I hope this is the November that makes up for the others. Believe me when I tell you how often I think of you and I really and truly say a prayer each and every day for you. I know your miracle is going to happen and I can feel that it's finally going to be soon. *hugs*

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    1. Thanks Amber! Yeah, let's hope this November is different than the last two have been.

      Just fyi....I never used prednisone, just lovenox and baby aspirin. However, I will most likely add in a low dose steroid for our "last chance" FET, but it will most likely be dexamethasone rather than prednisone. My RE just really does not want to use prednisone obviously, but I'll take the dex....they basically work the same way from what I know. Of course, my RE still claims this is just an "egg issue" or a "bad batch" from the first retrieval. I've got to say, that the more clues we find, the more I'm starting to believe him.

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  12. Emily - I had no idea it would be so invasive :( I'm so sorry to hear about the recovery, you probably Thought I was crazy because of my email to invite you up!!! I'm so glad that it is over and that you can move forward. One step closer to being a momma!!

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    1. No, I didn't think you were crazy. You've never had this stuff done either, so how would you know? I'm glad it's over too!

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  13. So glad you got the procedures covered and now you know. You don't have to wonder. Yay for not being nauseated. That was the worst part of my lap. I had a bad reaction to the anesthesia and was vomiting all day long...couldn't hold down pain pills and was so sore. It was rough. Wishing you a speedy recovery my friend!

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    1. My heart just goes out to you on that one Jessah. I cannot imagine throwing up on top of all of the tenderness and weirdness going on in your belly post-op. You poor thing! You are one strong woman for surviving that mess! :(

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  14. Wonderful news about coverage and glad you got a few answers. Prayers for success for next FET!

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  15. Wishing you a speedy recovery Emily! I was ready this post with baited breath. At this point...the only surgery that I haven't had is a laprascopy. I don't have any signs or indicaations of endo but I understand the idea of getting things ruled out....especially when insurance will pay for it! Maybe we'll both end up doing our last frozen transfer in November and get double BFPs!!!

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  16. So glad your insurance finally covered everything, what a blessing. Prayers to you on a speedy recovery. I too had the lap surgery done and I understand only being able to lay down or stand up. Did your shoulders hurt really bad from the anesthesia? That was the one thing that really bothered me the first day or so afterward. Keeping you in my prayers that this did the trick and you get your sweet baby in November :)

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    1. OMG the air trapped up in the shoulder area so annoying! I think that pain is from the CO2 that travels up into the body post-surgery, but it's 72 hours post-op now and it's still there....driving me insane. I feel like a Macy's Thanksgiving Day parade balloon with all this air that is trapped up under my rib cage, diaphragm, shoulders. I'm about to take a hollow pen and stab myself to release some of it! haha!

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  17. So glad that it's done (especially with just a $20 copay!) and that nothing more serious was found. Praying for quick recovery!!

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    1. Thanks woman! I appreciate the prayers!

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  18. Wow!! I've had two laps and two hysteroscopy's. The later were within 3 months of each other. There was never even a question from any RE about them being covered. Especially the laporoscopy. There are about 10,000 reasons they can code it to cover it. Painful period being the most common. Weird a doctor would ever tell you that would be out of pocket. I'm so glad that the financial end was all worked out so you could get the procedures you needed!! Such a relief I know. Hope the recovery is going well...I know for a few days it can make you a bit miserable! Hopefully you're getting past that by now. On to your successful FET!!! :)

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    1. And I'll mention I also have zero fertility coverage!

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    2. I agree. I think my RE truly just didn't feel the procedures were 100% necessary at first. A lot of RE's are skipping the lap in favor of moving straight into IUI or IVF these days, but I think it can be somewhat risky. At least do the hysteroscopy if nothing else! I mean, how do you REALLY know what's going on in there without looking closer first? Sure, some patients get lucky and get their take-home baby without ever having to go through surgery, but not everyone does. It's those patients (like me) who end up wondering after a failed IVF if something's being missed.

      Recovery is lame, as I'm sure you already know. I will live though! Getting a little better each day! ;)

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  19. I hope your recovery is going well. I just had the same thing at the beginning of the month. The nausea for a few days after was by far the worst part....and the major hormonal imbalance that caused me to cry every five minutes. I am super jealous that you only had to pay $20! Even with insurance covering part of it I had to spend A LOT. I also dont have any coverage for infertility treatments, so I was grateful to only spend about a thousand though! Hope you have a speedy recovery!

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    1. Thank you so much! I hope you are back to 100% by now physically. So grateful I didn't have the nausea, and I feel like I'm regaining about 10% of my normal self per day. I am always amazed at the human body during periods of recovery from surgery. I dunno...it just fascinates me how our bodies always seem to bounce back! So far so good...fingers crossed it continues this way.

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  20. How are you feeling Emily? I remember how long is took me to recover from my lap, it was frustrating... I felt like I plateaued and it seemed so much longer than the doctors said. I hope you are feeling well and I pray for a continued speedy recover.

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    1. I am doing fantastic Sarah! Yesterday and today were definitely the biggest turning points. About to start writing a blog about my recovery now actually...should be posted soon. Thanks for checking on me! You are too kind. :)

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  21. I told that if I wasn't already experiencing pain from the cyst on my fallopian tube, that it would have caused issues in the future, and it's good that it was removed.

    Video Colposcope | Fetal Monitor | Office Hysteroscopy

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